Surgical access port and method of using same

ABSTRACT

A surgical access port for insertion into a body cavity can have an elongate tubular body extending along an axis between a proximal end and a distal end, and a tip at the distal end of the tubular body for penetrating through a body wall and into the body cavity. The distal tip moves from a first, penetrating position to a second, retaining position when the body wall has been traversed. The surgical access port may further comprise a seal housing connected to the proximal end of the tubular body, the seal housing having an access port providing an opening into the tubular body to allow passage of surgical instruments. The distal tip may be sharp, pointed or bladed. The distal tip may also be substantially blunt or have a conical surface. The access port may further comprise a retention member for connecting the tubular body and the distal tip.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.10/805,864, entitled “SURGICAL ACCESS PORT AND METHOD OF USING SAME,”filed on Mar. 22, 2004, currently pending, the entirety of which isfully incorporated herein by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention generally relates to surgical access systems and, inparticular, to a surgical access port having an integral penetratingdistal tip and method of using same.

2. Discussion of the Prior Art

Laparoscopic surgery typically requires an access device such as atrocar. The term trocar generally refers to a combination of cooperatingelements such as a cannula, a seal housing and an obturator. The cannuladefines a pathway through a body wall; the seal housing provides anisolation of that pathway; and the obturator cuts or pierces the bodywall so that the cannula may be inserted. All three components areusually fitted together and used as a single unit for passage throughthe body wall and into a body cavity. Once the body cavity, or potentialbody cavity is reached with the trocar, the obturator is removed and thecannula and seal housing are used as a passageway into the body cavity.

Laparoscopic surgery can be initiated as follows: first, a large boreneedle is passed through a body wall and into the internal regionassociated with the body wall. Next, an inflation or insufflation gas ispumped into the internal region until it is properly distended. The bodywall and internal region are now ready for insertion of trocars.

A common method for inserting a trocar system through a body wall is asfollows: first, a small skin incision about the length of the diameterof the cannula is made. Second, the obturator and cannula are pushedinto the skin incision and are continually pushed until the system haspassed through the body wall and into the interior region associatedwith the body wall. Third, the obturator is removed from the trocarsystem. The cannula and seal housing are now ready for use.

Placing a sharp instrument such as an inflation needle or trocarobturator through a body wall and into an associated internal regioncomes with considerable risk. The human abdomen, for example, is atightly packed region that is filled with delicate structures andorgans. There is no open space between the abdominal wall and thosestructures or organs until inflation gas is inserted and apneumoperitoneum is established. Great care must be taken when placinginflation needles so as to avoid penetration of intestine, bowel orother structures. Most inflation/insufflation needles have a safetymechanism associated with the sharp end of the needle. Generally it is aspring loaded, blunted core that extends after the tip of the needle haspassed through the body wall. There remains, however, a constant riskassociated with the spring mechanism since the sharp needle tip extendsbeyond the safety core during the entire insertion process and somewhatbeyond.

Even after pneumoperitoneum is established, there is a risk of injuryduring placement of additional sharp instruments through the distendedbody wall. The body wall is comprised of skin, muscle, fat and a thinmembrane. The wall may be thick, muscular and tough or it may be leanand soft. As such, placement of a sharp obturator through the body wallrequires great skill and knowledge of what lies within the internalregion. The force required to insert a sharp trocar through a body wallcan exceed forty pounds in some cases. This applied force easilyovercomes the pneumoperitoneum and forces the body wall down and againstdelicate structures where there is the danger of piercing or cuttingthose structures.

This is not a new problem. Over the years there have been many solutionsproposed. The shielded obturators have spring loaded or spring drivensafety components that either cover the sharp portions of the obturatoror retract the sharp components within the obturator shaft. Thesemechanisms are complex, costly and not without risk. Many surgeons havealso used a technique referred to as a “cut down” procedure wheresuccessive small incisions are made until the body wall is cut through,at which time a cannula is inserted. Many feel that this procedure issafe but it is time-consuming and still has some associated risk sinceit continues to make use of a sharp instrument during the entire passagethrough the body wall. A sequential dilating system is another devicethat some surgeons use. This system comprises a sharp needle andassociated composite sleeve that are placed into the abdomen followed bya blunted obturator. This system continues to require insertion of asharp needle followed by the forceful placement of an obturator.

In all of the above prior art systems, the laparoscopic procedures beginwith the insertion of a sharp instrument at a nearly perpendicular angleto the body wall and followed by placement of the trocars with aforceful passage of either a sharp or blunted obturator through the bodywall. As explained above, a drawback of these systems is that the dangerof piercing or cutting internal structures still remains.

Accordingly, there is a need in the art for a system that minimizes therisk associated with insertion of the trocar cannula while allowing theuse of the most efficient penetrating profile.

SUMMARY OF THE INVENTION

The present invention relates to a surgical access port for insertioninto a body cavity having an elongate tubular body extending along anaxis between a proximal end and a distal end, and a tip disposed at thedistal end of the tubular body for penetrating through a body wall andinto the body cavity. The distal tip operates to move from a first,penetrating position to a second, retaining position when the body wallhas been traversed. As such, there is no need for a separate obturatorto be used with the access port of the invention. Furthermore, thedistal tip can act as an anchor to prevent accidental removal of thetubular body. The surgical access port may further comprise a sealhousing operably connected to the proximal end of the tubular body, theseal housing having an access port providing an opening into the tubularbody to allow passage of surgical instruments. The distal tip may besharp, pointed or bladed. The distal tip may also be substantially bluntor have a conical surface. The access port may further comprise aretention member for connecting the tubular body and the distal tip. Theretention member may be formed from metal or plastic, which may beoperably connected with a sidewall of the tubular body. The retentionmember may be biased to hold the distal tip in an off-axis position whenthere is no axial load, or it may be lightly held in axial alignment andsubsequently deflected in the presence of an instrument within thetubular body. The retention member may be one of a spring, spring wire,offset hinge or “living” hinge.

In one aspect of the invention, the distal tip repositions to one sideof the tubular body in a substantially right-angled condition in thesecond, retaining position. The distal tip may also reposition to oneside of the tubular body when no axial load is present to hold it inaxial alignment with the tubular body. It is appreciated that therepositioned tip remains in an off-axis condition until removal of theaccess port, at which time the distal tip automatically realigns withthe axis of the tubular body as the access port is withdrawn from thebody wall. The distal tip may also comprise at least two or more partsor petals that reposition to the side of the tubular body in the second,retaining position. The tubular body may be a thin walled tube sized andconfigured to allow passage of surgical instruments through the bodywall and into the body cavity. The distal tip may comprise a conical,tapered or rounded shape to separate tissue layers and to provide asmall fascial defect through which the tubular body can pass. The distaltip may be solid or hollow. The hollow distal tip may act as a specimenbag by closing on a specimen and pulled inside the tip during removal ofthe access port.

The distal tip may be formed from a clear material to allow viewingthrough an endoscope during placement of the surgical access port. Theconical surface of the tip may have at least one tissue engaging raisedpattern on the surface. The conical surface operates to facilitateinsertion of the access port with a reduced penetration force andminimize tenting of the body wall. The conical surface may furtherfacilitate separation of different layers of the body wall and providesproper alignment of the tip between the layers. In another aspect of theinvention, the distal tip may have an outer surface extending distallyto a blunt point and includes a pair of side sections separated by anintermediate section, and wherein the side sections extend from theblunt point radially outwardly with progressive positions proximallyalong the axis. The side sections may include a distal portion inproximity to the blunt point and a proximal portion in proximity to thetubular body, and the distal portion of the side sections being twistedradially with respect to the proximal portion of the side sections.

In yet another aspect of the invention, a method of inserting a surgicalaccess port into a body cavity is disclosed. The method comprises thesteps of: providing the surgical access port having an elongate tubularbody extending along an axis between a proximal end and a distal end,and a distal tip operably connected at the distal end of the tubularbody; and inserting and advancing the distal tip through a body wall andinto the body cavity. The method may further comprise the step of makinga small skin incision with the distal tip. A feature of the invention isthat the distal tip moves from a first, penetrating position to asecond, retaining position when the body wall has been traversed withouta need for a separate obturator. The method of the invention furthercomprises the step of removing the access port from the body cavityafter a procedure is complete. It should be noted that during theremoval of the access port, the distal tip, which may comprise of one ormore part or petal, automatically realigns with the axis of the tubularbody as the access port is withdrawn from the body wall.

These and other features and advantages of the invention will becomemore apparent with a discussion of preferred embodiments in reference tothe associated drawings.

DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a conventional laparoscopic access port having acutting tip;

FIG. 2 illustrates a conventional laparoscopic access port having ablunt tip;

FIG. 3 is a top-perspective view of the conventional laparoscopic accessport of FIG. 1 showing the proximal position of an obturator handle;

FIG. 4 is a top-perspective view of a laparoscopic access port accordingto the first embodiment of the invention showing the seal housing withno obturator in place;

FIG. 5 illustrates the first step in placing the access port of theinvention through a body wall;

FIG. 6 illustrates the second step in placing the access port of theinvention through a body wall;

FIG. 7 illustrates the third step in placing the access port of theinvention through a body wall;

FIG. 8 illustrates the removal step for removing the access port of theinvention through a body wall;

FIG. 9 is an enlarged view of the initiation of the removal step of FIG.8;

FIG. 10 is an enlarged view of the completed removal step of FIG. 8;

FIG. 11 is a schematic view of the distal cannula portion in a retentionposition;

FIG. 12 is a schematic view of the distal cannula portion in aninsertion or removal position;

FIG. 13 is a side-section view of a tissue separating distal cannulaportion in accordance with another embodiment of the invention having ahinge member and a centering portion;

FIG. 14 is an end view of the tissue separating distal cannula portionof FIG. 13;

FIG. 15 is a side-section view of a distal cannula portion having acentering portion in accordance with another embodiment of theinvention;

FIG. 16 is a side-section view of the tissue separating distal cannulaportion of is FIG. 13 in a partial retention condition;

FIG. 17 is a perspective exploded view of a cannula in accordance withanother embodiment of the invention, illustrating the placement of aspring-hinge in a solid distal tip;

FIG. 18 is a perspective exploded view of a cannula in accordance withanother embodiment of the invention, illustrating the placement of aspring-hinge in the cannula wall;

FIG. 19 is a perspective view of the cannula of FIG. 18 with thespring-hinge being placed in the cannula wall; and

FIGS. 20( a)-20(c) illustrate perspective views of an access port havinga single-piece distal tip, a two-piece distal tip and a three-piecedistal tip, respectively.

DESCRIPTION OF PREFERRED EMBODIMENTS AND BEST MODE OF THE INVENTION

Referring to FIGS. 1-3, there are shown conventional laparoscopic accessport to systems of the prior art. In particular, FIG. 1 illustrates aconventional laparoscopic access port system 10 having a cutting tip 12.FIG. 2 illustrates a conventional laparoscopic access port system 20having a blunt tip 22; and FIG. 3 illustrates a top-perspective view ofa conventional laparoscopic access port system 30 showing a proximalposition of an obturator handle 32. In each of the above conventionallaparoscopic access port systems 10, 20, 30, there are included acannula or elongate tubular body 14, 24, 34, a seal housing 16, 26, 36,respectively, and an obturator (not shown). The cannula 14, 24, 34 forthe respective access port system 10, 20, 30 provides a tubular pathwaythrough a body wall. The seal housing 16, 26, 36 provides isolationbetween the two sides of the body wall. The obturator provides a cuttingor dilating instrument for placing the cannula through the body wall.The three combined elements of the access port system—cannula, sealhousing and obturator—are generally referred to as a “trocar”.

Referring to FIG. 4, there is shown a top-perspective view of alaparoscopic access port 40 according to the first embodiment of theinvention. The access port 40 includes a cannula or elongate tubularbody 42 having a proximal end and a distal end, a seal housing 44operably connected at the proximal end of the cannula 42, and an accessport 46 formed in the seal housing 44. A feature of the invention is itcontemplates the use of the access port system 40 without the need foran obturator. An advantage of the invention is it simplifies theinsertion of an access port through a body wall. In particular, with theaccess port 40 of the invention, at least the following steps ofoperating the conventional access port systems of the prior art will beeliminated: (1) placing an obturator into an access port; (2) holdingthe obturator in place during placement of the access port; (3)subsequently removing the obturator when access is complete; and (4)disposal of the obturator. The distal end of the cannula 42 comprises atip 48 that is sized and configured to guide the tubular portion of thecannula 42 through a body wall. Distal tip 48 may be sharp, pointed orbladed. In one aspect of the invention, the tip 48 comprises asubstantially blunt or rounded frusto conical structure having at leastone tissue engaging helical raised pattern upon the conical surface.

Referring to FIGS. 5-10, there is shown a method of inserting thesurgical access port of the present invention and, in particular, thereare shown a series of illustrations of the surgical access port in useto provide access through a body wall and into an internal portion of abody. First, an entry is initiated by a small skin incision asillustrated in FIG. 5, followed by insertion of the distal portion ofthe access port 42 as illustrated in FIG. 6. The access port 40 isadvanced into the fascial defect until the innermost layer of tissue ispenetrated. When the distal portion of the access port 40 passes throughthe final layer of tissue, it repositions itself to one side of thecannula 42 as illustrated in FIG. 7. The repositioned distal tip 48remains in a substantially right-angled, off-axis, condition untilremoval of the access port. The distal tip 48 automatically realignswith the axis of the cannula 42 as the access port is withdrawn from thebody wall as illustrated in FIG. 8. FIGS. 9 and 10 are enlarged views ofthe initiation and completion of the removal step of FIG. 8.

Stated another way, the present invention contemplates the use of adistal portion that separates body tissue rather than cutting thetissue. The resulting residual defect is minimal and easily corrected.In addition, the blunt or rounded configuration of the distal tip allowsit to remain in the angled, off-axis condition during use since thereare no sharp, pointed or cutting elements associated with the distalportion.

FIGS. 11-16 illustrate the details of the construction of access port 40according to the present invention. In particular, access port 40comprises a cannula or elongate tubular body 42 having a proximal endand a distal end, seal housing 44 operably connected at the proximalend, and tip 48 disposed at the distal end. Cannula 42 is formed from avery thin walled tube that is sized and configured to allow passage ofsurgical instruments through a body wall and into a body cavity. Thedistal tip 48 may be solid or hollow. The hollow tip may act as aspecimen bag by closing on a specimen and pulled inside the tip duringremoval of the access port. The tip 48 is sized and configured tofacilitate the placement of the tubular cannula 42. The tip 48 comprisesconical, tapered or rounded shape that separates tissue layers andprovides a small fascial defect through which the associated cannula 42may pass. A metal or plastic retention member 47 is associated with thesidewall of the cannula tube and extends into the distal tip 48. Thedistal tip 48 may swing to one side when no axial load is present tohold it in axial alignment with the cannula tube. The retention member47 may be biased to hold the distal tip 48 in an off-axis position whenthere is no axial load or the tip 48 may be lightly held in axialalignment and subsequently deflected in the presence of instrumentswithin the cannula 42. FIGS. 20( a)-20(c) illustrate perspective viewsof a single-piece 48(a), a two-piece 48(a)/48(b) and a three-piece48(a)/48(b)/48(c) distal tip, respectively, that may swing to the sideof the tubular cannula 42 when no axial load is present to hold them inaxial alignment with the tubular cannula 42.

A biased condition may be achieved using a spring, spring wire, offsethinge or a plastic “living” hinge. Considering the thin-wall nature ofthe cannula itself, a substantially flat ribbon of metal may comprise apreferred embodiment in the present invention where the ribbon is insertmolded or fitted into the wall of the cannula and subsequently insertedinto a slot in the distal tip. The ribbon may be configured to bias thedistal tip in either the axial or off-axis condition or both. A détenteor over-center configuration may be achieved by forming the hinge-ribboninto a cross sectional semi-circle to match the cross section of thecannula tube. The semi-circular cross section of the ribbon results in a“snap-over” or “click” that places the tip in axial alignment or,alternately, out of axial alignment upon urging from an includedinstrument. A rounded or tapered proximally facing extension upon theproximal end of the distal tip that is sized and configured to fit or“nest” into the distal end of the cannula tube assures correct axialalignment of the tip and the cannula.

Referring to FIGS. 17-19, there is shown another aspect of the presentinvention including alignment features associated with the distal tipand the cannula tube. Proximally facing extensions associated with thetip fit into distally facing slots or features associated with thedistal end of the cannula. These features allow the assembly to betwisted without challenging the retention member.

It will be understood that many other modifications can be made to thevarious disclosed embodiments without departing from the spirit andscope of the invention. For these reasons, the above description shouldnot be construed as limiting the invention, but should be interpreted asmerely exemplary of preferred embodiments.

The invention claimed is:
 1. A surgical access port comprising: alongitudinal axis; an instrument access channel extending from aproximal and to a distal end thereof and substantially aligned with thelongitudinal axis; an elongate tubular body comprising a lumen throughwhich the instrument access channel extends, the tubular bodydimensioned for traversing a body wall into a body cavity; a sealhousing disposed at a proximal end of the tubular body; a blunt, tissuepenetrating tip; and a retention member extending from the elongatetubular body into the tip and pivotably connecting the tip to a distalend of the tubular body, and wherein the access port has a firstconfiguration in which the tissue penetrating tip is substantiallyaligned with the longitudinal axis and substantially blocks theinstrument access channel, the access port has a second configuration inwhich the tissue penetrating tip is not aligned with the longitudinalaxis and does not block the instrument access channel, advancing theaccess port through tissue maintains the access port in the firstconfiguration, and the retention member biases the tip in the secondconfiguration when no axial load is on the tip.
 2. The surgical accessport of claim 1, wherein the tissue penetrating tip separates tissue onadvancement therethrough.
 3. The surgical access port of claim 1,wherein the tissue penetrating tip is substantially frustoconical. 4.The surgical access port of claim 1, wherein the tissue penetrating tipcomprises a plurality of parts or petals.
 5. The surgical access port ofclaim 1, wherein the tissue penetrating tip comprises a transparentmaterial.
 6. The surgical access port of claim 1, wherein the retentionmember comprises at least one of a spring, spring wire, offset hinge,and a living hinge.
 7. A surgical access port for insertion into a bodycavity, comprising: a trocar cannula comprising an elongate tubular bodyextending along an axis between a proximal end and a distal end, theelongate tubular body having a lumen extending between the proximal endand the distal end; an obturator tip connected to and disposed at thedistal end of the tubular body for penetrating through a body wall andinto the body cavity, the tip in a first, penetrating position blockingthe lumen of the elongate body; and a retention member connecting thetrocar cannula to the obturator tip, wherein the retention member isfitted into the distal end of the elongate tubular body and insertedinto a slot in the obturator tip; wherein the tip pivots from the first,penetrating position to a second, retaining position, the tip swingingaway from the elongate body unblocking the lumen of the elongate body,when the body wall has been traversed and wherein the tip automaticallyrealigns with the axis of the tubular body to the first position as theelongate tubular body is withdrawn from the body wall.
 8. The surgicalaccess port of claim 7, wherein the retention member is formed frommetal or plastic.
 9. The surgical access port of claim 7, wherein theretention member is biased to hold the tip in the second position whenthere is no axial load.
 10. The surgical access port of claim 7, whereinthe obturator tip is lightly held in axial alignment in the firstposition and subsequently deflected to the second position in thepresence of an instrument within the tubular body.
 11. The surgicalaccess port of claim 7, wherein the retention member is one of a spring,a spring wire, an offset hinge or a “living” hinge.
 12. The surgicalaccess port of claim 7, wherein the retention member is formed from aribbon of metal.
 13. The surgical access port of claim 12, wherein theribbon of metal has a detent configuration defining a tactile snap whenthe obturator tip is repositioned between the first position and thesecond position.
 14. The surgical access port of claim 12, wherein theribbon of metal has a cross-sectional profile of a semi-circle.
 15. Thesurgical access port of claim 7, wherein the obturator tip furthercomprises a proximal extension sized and configured to engage the distalend of the elongate tubular body and to maintain axial alignment of theobturator tip and the elongate tubular body.
 16. A surgical access portfor insertion into a body cavity, comprising: a trocar cannulacomprising an elongate tubular body extending along an axis between aproximal end and a distal end, the elongate tubular body having a lumenextending between the proximal end and the distal end; an obturator tippivotally connected to and disposed at the distal end of the tubularbody for penetrating through a body wall and into the body cavity, thetip in a first position blocking the lumen of the elongate body, theobturator tip comprising an outer surface extending distally to a bluntpoint and a pair of side sections extending from the blunt pointradially outward with progressive positions proximally along the axis,the side sections each having a distal portion in proximity to the bluntpoint and a proximal portion in proximity to the tubular body, thedistal portion being twisted radially with respect to the proximalportion; and wherein the obturator tip is pivotable from the firstposition to a second position such that the obturator tip is pivotedaway from the elongate body unblocking the lumen of the elongate body inthe second position.
 17. The surgical access port of claim 16, whereinthe obturator tip is biased to the second position when there is noaxial load on the tip.
 18. The surgical access port of claim 16, furthercomprising a retention member pivotally connecting the obturator tip tothe trocar cannula.